Small Fiber Neuropathy Symptoms Diagnosis and Treatment
Small fiber neuropathy is really an interestingcondition because it consists typically of just burning, numbness, pain of the feet,sometimes the hands later on without necessarily having any abnormalities on your EMG or nerveconduction study. So what I tell patients and actually residents or students who trainunder us is that a normal nerve conduction study does not exclude a neuropathy. And wewill confirm this by doing additional testing, specifically the nervous the the examinationat the bedside asking patients about their symptoms, for example, loss of sensation tocool or or hot temperatures, loss of pain sensation and also doing skin biopsies wherewe look at nerve densities in the skin both
from the calf and the thigh as well as doinga special test that looks at sweat function both in your foot in in the legs as well asthe feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typicallywill progress unless the underlying cause is identified and reversed. Diabetes of coursebeing the most common cause is always screened for. But once the more common causes are excludedand the focus becomes on excluding any underlying secondary disease process but also controllingpain because if patients' symptoms of pain are generally controlled they tend to do prettywell and really have no other major functional deficits. I've really become interested overthe years is how interconnected neurology
and rheumatology are and one thing I oftendo on patients who have unexplained small fiber even autonomic neuropathy is have themsee rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren's orsarcoid and sometimes even if we are not directly involved in treating the patients, this canbe the first sign of an underlying connective tissue disorder that can then be brought tothe attention of rheumatology and addressed from their standpoint.
Peripheral Nervous System Disorders Diagnosis and Treatment
The peripheral nervous system is the partof the nervous system that excludes or is outside of the brain and the spinal cord.We take care of patients that have disorders that affect the motor neurons, which livein the spinal cord â€“ the peripheral nerves that extend out into the arms and legs aswell as the muscles and the connection between the nerves and the muscles. Some of the disordersthat a nerve and muscle a disease specialist will evaluate and develop care plans for includemuscle disorders such as muscular dystrophy, polymyositis, dermatomyositis, peripheralneuropathies such as Charcot Marie Tooth disease or hereditary neuropathy and as well as theneuromuscular junction disorders such as myasthenia
gravis. Some symptoms that can be associatedwith the peripheral nervous system include generalized weakness, fatigue, numbness, tingling,sometimes pain can be caused by disorders of the peripheral nerve. The evaluation ofa patient with a possible peripheral nervous system disorder first begins with the verycareful history to understand how the symptoms started and how they affect the patient. Fromthe history we extend to the physical exam, which helps us determine what sort of deficitsmay be impacting the patient's function. From there we design a targeted testing strategyto to try to pinpoint exactly what's causing the symptoms. It's a very exciting time inneuromuscular medicine because the more we
understand about how these diseases occur,the more that we can develop very targeted, personalized treatments to help either stopor reverse the disease. In many cases there may not be a specific cure but we can reducethe symptoms through a comprehensive treatment plan.
Voiceover: In this tutorial,I'm going to talk about somatosensation in theperipheral nervous system. Somatosensation refersto senses of the body. That includes a wholebunch of different senses, but I like to think aboutfive senses in particular, which turn out to be reallyuseful for medical purposes because we can test them on examination. The first of these we call position sense,
by which we mean theposition of body parts relative to each other. For example, if you close your eyes and somebody lifts yourarm above your head, you can feel that your arm has been moved. You don't actually haveto see it to know that. Another sense of thebody is vibration sense. If we come into contact
with anything that'svibrating we can feel that. We often use little tuning forks when we're examining patients, to see if they have normal ability to feel something vibrating. The next sense is touch. I'm going to write thatin a different color, and I'll come back to why I'm using
these different colors in a minute. Then we have pain and temperature. Temperature. Let me just write a little quot;Rquot;here to represent a receptor for one of these types of somatosensation, because to be able to senseanything, you need a receptor. Something that can detectthat type of stimulus. There are many different types of
somatosensory receptors, and we lump them into a few different categories. The first big category ofsomatosensory receptors respond to physical forces, so we call those mechanoreceptors, because they respondto mechanical stimuli. Mechanoreceptors. Receptors in the categoryof mechanoreceptors
can detect the position of body parts, relative to each other,and vibration, and touch. Then there are other receptors for the senses of pain and temperature, which I'll just representwith a bit quot;Rquot; here. Somatosensory receptors thatcan detect noxious stimuli, that can create the experienceof pain, we call nociceptors. Nociceptors.